PLANO NEGOU CIRURGIA POR HIPERTROFIA MAMÁRIA?

Did your health insurance plan deny surgery for breast hypertrophy? Many people think this type of procedure is always "cosmetic." But that's not quite the case. When breast hypertrophy causes pain, discomfort, functional limitations, and there is a medical indication, the discussion changes—and the insurance plan's denial can be challenged. In the video, I explain directly when coverage may be applicable. Guilherme Collin OAB/RS 48.682 📞 (51) 3228-1219 📲 WhatsApp: (51) 99985-7991 #HealthPlan #BreastHypertrophy #BreastReduction #ReconstructiveSurgery #HealthLaw #CoverageDenial #Lawyer #GuilhermeCollin #OABRS48682 TJSP – Civil Appeal 1125767-22.2023.8.26.0100, Rel. Márcia Tessitore, j. 08/15/2024. The plaintiff had thoracic hyperkyphosis due to overload from breast volume, compensatory lumbar hyperlordosis, and intense pain/limitations. The court upheld the judgment of merit, recognized the abusiveness of the denial, and maintained the operator's conviction to pay material damages of R$ 23,137.28 and moral damages of R$ 10,000.00. TJSP – Civil Appeal 1001074-29.2024.8.26.0100, Rel. Jane Franco Martins, j. 03/24/2025. The case involved bilateral gigantomastia with grade III ptosis and indication for non-aesthetic reduction mammoplasty to treat a spinal condition. The judgment of dismissal was overturned: the court affirmed that, given the medical need and therapeutic nature, coverage cannot be excluded; moral damages were dismissed. TJSP – Civil Appeal 1012879-75.2024.8.26.0068, Rel. Schmitt Corrêa, j. 03/09/2025. The insured, a minor, presented with bilateral gigantomastia and thoracolumbar scoliosis, with a prescription from an orthopedist for reconstructive surgery. The judgment upheld the obligation to reimburse the reduction mammoplasty, highlighting that the surgery was corrective, not cosmetic, and that the requirements of art. 10, §13, of Law 9.656/98, as amended by Law 14.454/2022, were met; moral damages were excluded. TJSP – Civil Appeal 1028057-36.2021.8.26.0564, Rel. Theodureto Camargo, j. October 8, 2025. The plaintiff was diagnosed with gigantomastia, and an expert report indicated that the reduction mammoplasty was restorative, not aesthetic. The judgment upheld the health plan's obligation to cover the procedure, invoking Law 14.454/2022, the lack of an effective alternative treatment in the list of covered procedures, and even a favorable technical note from NatJus; the only change was to dismiss the claim for moral damages. TJRJ – Official news published on September 16, 2025, regarding the judgment of the Ninth Chamber of Private Law. The court reported that it upheld a decision ordering Vision Med to pay material and moral damages to a patient with breast hypertrophy and orthopedic repercussions such as disc protrusion, lower back pain, and lumbar hyperlordosis, after denying coverage for reduction mammoplasty. The news also records the invocation of TJRJ Precedent 339 regarding moral damages for undue refusal of coverage.